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Pallor indicates Anemia (Hemoglobin) Cyanosis idicates (Blue color) Decreased oxygen in the blood or decreased blood flow (restriction, cold, ect.) Jaundice indicates (Yellowing of the skin) increased bilirubin which can arise from breakdown of heme in the red blood cells. Causes of generalized itching without apparent rash Dry skin, pregnancy, uremia, jaundice, lymphomas/leukemia, drug reactions, and polycythemia vera/thyroid disease. Moisturizers replace The lost moisture barrier
NURS 607 Advanced Physical Assessment
FINAL EXAM LATEST 2025 GRADED A+
VERIFIED ANSWERS 100%
What is the most common cause of diffuse hair thinning? Male and female pattern baldness Hair loss/shedding at the ROOTS indicates: Telogen effluvium and alopecia areata Hair loss/shedding along the SHAFT indicates: Damage from hair care OR tinea capitis Macule A circumscribed flat area of change in color of the skin <1cm in diameter (Freckles, flat moles, port-wine stains, rickettsial infections, rubella, and measles) Patch A circumscribed flat area of change in color of the skin >1cm in diameter. Papule A small, solid elevation of the skin <1cm in diameter (Nevi, warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some acne, and skin cancers) Plaque
Psoriasis is found: Often located on the scalp, extensor surfaces of the elbows and knees, umbilicus, and gluteal cleft. Lichen is found: Arises on the wrists, forearms, genitals, and lower legs. Vitiligo is found: In patchy, isolated portions of the distal extremities and face, particularly around the eyes and mouth. Discoid lupus erythematosus is found: On the sun-exposed skin of the face (forehead, nose, and ear) Hidradenitis suppurativa is found: In the skin that contains a large amount of apocrine (sweat) glands (Axillae, groin, and under the breasts) What does ABCDE-EFG mean? A-Asymmetry B-Border C-Color (Blue/Black)
D-Diamter (>6 mm) E-Evolving E-Elevation F-Firmness G-Growing Stage 1 Pressure Injury Intact skin with localized area of non-blanchable erythema Stage 2 Pressure Injury Partial-thickness skin loss with exposed dermis Stage 3 Pressure Injury Full-thickness skin loss in which fat is visible in the injury; slough and/or eschar may be present. Rolled wound edges are often present. Stage 4 Pressure Injury Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Unstageable Pressure Injury Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.
Where is a chest tube placed? 5th intercostal space at the anterior or midaxillary line Where will an ETT be seen on an X-Ray? Level of the 4th rib What is the landmark for a thoracentesis? The intercostal space between the 7th and 8th rib What is the "triangle of safety"? The midaxillary formed by the lateral boarder of the pectoralis major muscle anteriorly, lateral boarder of the latissimus dorsi posteriorly, and the nipple line (4th or 5th intercostal space) inferiorly. This is a "safe space" for chest tube insertion. Where is aspiration pneumonia more common? In the right middle and lower lobe because the right main bronchus is more vertical. This will also be the location of an ETT if inserted too far. What are the causes of acute cough? Most common: Viral upper respiratory infections. Other: acute bronchitis, pneumonia, left-sided heart failure, asthma, foreign body, smoking, ACE-inhibitor therapy.
What are some causes of subacute cough? Post-infectious cough, pertussis, acid reflux, bacterial sinusitis, and asthma. What are some causes of chronic cough? Postnasal drip, asthma, gastro-esophageal reflux, chronic bronchitis, bronchiectasis. Translucent, white, or gray sputum: Mucoid sputum that is often seen in viral infections and cystic fibrosis. Yellow or green sputum: A bacterial infection or bacterial pneumonia. Foul smelling sputum: Anaerobic lung abscess. Pain in the myocardium can indicate: Angina pectoris, myocardial infarction, myocarditis Pain in the pericardium can indicate:
Signs and symptoms of obstructive sleep apnea (OSA): Daytime sleepiness, fatigue, snoring, apnea (>10sec), awakening with a choking sensation, or a morning HA. Cyanosis in the lips, tongue, and oral mucosa signals Hypoxia Pallor and sweating (diaphoresis) are common in Heart failure Stridor A strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx that requires an urgent airway evaluation. Accessory muscle use can indicate: Increased ventilatory requirements due to airways and/or parenchymal lung disease. or respiratory muscle fatigue. Lateral displacement of the trachea occurs in: Pneumothorax, pleural effusion, and atelectasis.
Anteroposterior (AP) diameter NORMALLY 0.7-0.75. Should be less than the transverse diameter 1:2. If it is the same then it is known as "barrel chest" --> chronic emphysema (COPD-0.9) Retractions occur in: Severe asthma, COPD, or upper airway obstructions. Unilateral impairment or lagging indicates: Pleural disease from asbestosis or silicosis; it is also seen in phrenic nerve damage or trauma. Crepitus and chest wall edema are seen in: Mediastinitis Silent gap between inspiratory and expiratory sounds indicates: Bronchial breath sounds. Wheezing arises in: Narrowed airways of asthma, COPD, and bronchitis. Dullness on percussion of the chest wall can indicate: An airway obstruction from inflammation or secretions.
OSA Screening: Sleep studies that show the number of apnea (breathing stops for >10 seconds) and hypopnea (breathing flow reduction that is paired with a decrease in oxygen). Normal breathing 14 - 20 breaths per minute and up to 44 per minute in infants Slow Breathing (Bradypnea) Slow breathing with or without an increase in tidal volume that maintains alveolar ventilation. Abnormal alveolar hypoventilation without increased tidal volume can arise from uremia, drug- induced respiratory depression, and increased intracranial pressure. Sighing respiration Breathing punctuated by frequent sighs should alert you to the possibility of hyperventilation syndrome—a common cause of dyspnea and dizziness. Occasional sighs are normal Rapid shallow breathing (Tachypnea)
Rapid shallow breathing has numerous causes, including salicylate intoxication, restrictive lung disease, pleuritic chest pain, and an elevated diaphragm. Cheyne-Stokes breathing Periods of deep breathing alternating with periods of apnea. This pattern is normal in children and older adults during sleep. Causes include heart failure, uremia, drug-induced respiratory depression, and brain injury (typically bihemispheric). Obstructive breathing In obstructive lung disease, expiration is prolonged due to narrowed airways increase the resistance to air flow. Causes include asthma, chronic bronchitis, and COPD. Rapid Deep Breathing (Hyperpnea, Hyperventilation) In hyperpnea, rapid deep breathing occurs in response to metabolic demand from causes such as exercise, high altitude, sepsis, and anemia. In hyperventilation, this pattern is independent of metabolic demand, except in respiratory acidosis. Light-headedness and tingling may arise from decreased CO2 concentration. In the comatose patient, consider hypoxia, or hypoglycemia affecting the midbrain or pons. Kussmaul breathing is compensatory overbreathing due to systemic acidosis. The breathing rate may be fast, normal, or slow. Ataxic Breathing (Biot's Breathing) Breathing is irregular—periods of apnea alternate with regular deep breaths which stop suddenly for short intervals. Causes include meningitis, respiratory depression, and brain injury, typically at the medullary level.
Mediastinal crunch (Hamman's sign) Series of periocordial crackles synchronous with the heart beat, not with respiration. Best heard in left lateral position and are often due to mediastinal emphysema (Pneumomediastinum). Produces severe chest pain and can be spontaneous. (Tracheobronchial injury, blunt trauma, pulmonary disease, use of recreational drugs, childbirth, and rapid ascent from scuba diving). Lymphatic drainage of the breast follow the veins to Axilla; 75% of the lymphatics drained by axillary nodes (pectoral, parasternal, & clavicular groups) What is gynecomastia?
- benign enlargement of breast in males (>2cm)
- associated with increased estrogen/decreased testosterone (hormonal levels, meds) Medications associated with breast pain include: Hormone replacement therapy, psychotropic drugs (SSRI's, haloperidol spironolactone) and digoxin. Peau d'orange sign When the skin of the breast looks like skin of an orange (thickening and prominent pores), inflammatory breast cancer Paget disease of the breast
Eczematous changes with rash, scaling, or ulceration on the nipple extending to the areola; associated with underlying ductal or lobular carcinoma. Tender subareolar cords suggest Mammary duct ectasia, a benign but sometimes painful condition of dilated ducts with surrounding inflammation and, at times, with associated masses. A mobile mass that becomes fixed when arm relaxes attached to the ribs and intercostal muscles A mass that is fixed when hand is pressed against the hip attached to the pectoral fascia Nonpuerperal galactorrhea milky discharge unrelated to a prior pregnancy and lactation. Causes include hypothyroidism, pituitary prolactinoma, and drugs that are dopamine agonists, including many psychotropic agents and phenothiazines Acanthosis nigricans Deeply pigmented velvety axillary skin that is associated with diabetes, obesity, PCOS and rarely malignant paraneoplastic disorders. Breast cancer screening
Repetitive strain, or overuse syndromes, crystal-induced arthritis, RA, psoriatic arthritis, reactive arthritis, and infectious arthritis. Age may also provide clues to causes of joint pain. If younger than 60 y/o consider: OA, gout and pseudogout, polymyalgia rheumatica (PMR), osteoporotic fracture, and septic bacterial arthritis. Myalgias Generalized muscle aches and pains Arthralgia Joint pain without evidence of arthritis Pain in a single joint suggests: Injury, monoarticular arthritis, or extra-articular causes like tendinitis, bursitis, or soft tissue injuries. Oligoarticular (pauciarticular) arthritis can result from: Infection (gonorrhea or rheumatic fever, connective tissue disease and OA) Causes of polyarthritis include Viral or inflammatory from RA, systemic lupus erythematosus (SLE), or psoriasis.
Spondyloarthropathies (e.g. psoriatic arthritis) often involve: The spine, including sacroilliac joints and medium-to-large joints (shoulders, hips, knees, and ankles). RA and SLE include: Smaller joints (Wrists, fingers, and toes). If the pattern of involvement is asymmetric: Psoriatic, reactive, and inflammatory bowel disease (IBD)-associated arthritis. If the pattern of involvement is symmetric and additive/progressive RA If the pattern of involvement is symmetric and migratory Rheumatic fever and gonococcal arthritis Severe pain of rapid onset in a red, swollen joint Occurs in acute septic arthritis or crystalline arthritis (gout; CPPD). In children consider osteomyelitis in a bone contiguous to a joint.
